Individual
JARED EVAN BUKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1775 BALLARD RD FL 2, PARK RIDGE, IL 60068-1005
(847) 318-6020
(847) 318-2341
Mailing address
1775 W DEMPSTER ST FL 2, PARK RIDGE, IL 60068-1143
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
125.084281
IL
Other
Enumeration date
03/25/2024
Last updated
06/13/2024
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